Choosing Prisons Over Hospitals: How We Treat the Mentally Ill

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The United States is stepping up to house the mentally ill, but in the worst way possible: prison. According to a startling Mother Jones report, for every one mentally ill patient undergoing treatment at a hospital, there are ten more mentally ill people incarcerated. That’s not treating the problem, that’s just stashing away the problem.

Only a couple of centuries ago, locking up mentally ill people was standard practice. However, since then, advancements in psychology and health services have made it clear that there are ways to treat and/or medicate people afflicted with mental illness so that they may be reintegrated into society. The fact that we know how to handle these issues and still choose to throw patients in jail rather than a hospital is a sad commentary on our priorities.

Interestingly, though, as Mother Jones points out, it’s not even a practical approach for the state to take from a financial standpoint. Washington state found that its mentally ill inmates cost them more than three times more to house than a typical prisoner, while Florida realized that it was paying to keep mentally ill inmates in jail twice as long due to perceived “bad behaviors.” It’d be understandable – not conscionable, but understandable – if the courts were sending the mentally ill to jail in order to save money, but since it just winds up costing the government more than providing them with adequate hospitalization, it’s a flawed plan on multiple levels.

It’s not as if people within the system aren’t attempting to make reform happen, though. A Virginia Beach sheriff volunteered to give up some of the state money allotted to his jails so it could be reallocated to mental health hospitals instead. His hope was that doing so would allow some of his sickest inmates to get the care they actually needed, rather than the care they received in his prison.

Other prison employees vented their frustrations over being unprepared to help inmates with their mental illnesses. They describe countless instances of self-harm and disruptions. A Mississippi deputy spoke of one prisoner who “tore up a damn padded cell that’s indestructible, and… ate the cover of the damn padded cell. We took his clothes and gave him a paper suit to wear and he ate that. When they fed him food in a Styrofoam container, he ate that. We had his stomach pumped six times, and he’s been operated on twice.”

Alas, even mental health advocates are skeptical that Congress will provide the necessary funding to provide more hospital alternatives to prisons, given the divisive political climate. Therefore, one of the best temporary solutions is to help the mentally ill from appearing in courtrooms in the first place. Research shows that training police officers for as little as one day about mental illness helps to reduce the prison population. Since 10 percent of calls to the police are to report the actions of someone dealing with a mental illness, this knowledge can help the police to handle situations without always concluding in an arrest.

As a psychiatric nurse I agree with Barbara L. However currently we cannot "commit" a person to a psychiatric hospital unless two psychiatrists agree that he/she is a danger to him/herself and/or others. It is very easy to fool the psychiatrist and "the system" often does not know that a person is a danger until he/she has actually committed a crime. Psychiatric patients sometimes prefer prison incarceration to hospitalization especially in a place where the prison system is relatively humane, like in New York State or if they will only be in a local jail. They prefer knowing when they will get out rather than having something open ended as in a psychiatric hospital where they can stay indefinitely at the whim of the psychiatrist. Also in SOME cases a prisoner may actually have more freedom in prison, especially a local jail, than in the psychiatric hospital. He/she might be able to go to the yard outside more often and sometimes without being escorted, in some cases he/she may even be able to work in the community, recreational and educational facilities in prison might be better, and in some cases there may even be more opportunity in the prison than the hospital for consensual sex. Furthermore, rape can happen in psychiatric hospitals too.